Chris Kresser AUGUST 31, 2014 AT 11:00 AM The vitriol, bias, and polarized thinking surrounding this issue never ceases to amaze me. Especially because the following conclusions are, according to research, clinical experience, and common sense, fairly straightforward: 1. Few, if any, traditional cultures regularly consumed a ketogenic/VLC diet. It is not our “default nutritional state” as many have claimed. 2. Ketogenic/VLC diets are effective therapeutically in certain situations, such as metabolic syndrome/obesity and neurological conditions such as epilepsy and Alzheimer’s. However, even in these cases there may be side effects (such as adverse changes to the gut microbiota) when these diets are followed long-term—some of which we’re only beginning to understand. 3. The fact that ketogenic and VLC diets work well therapeutically for certain conditions does not make them appropriate in all circumstances. People with hemochromatosis need to limit their iron intake, but that doesn’t mean everyone does. 4. Some people obviously do better with ketogenic/VLC diets than others. Should this really come as a surprise to anyone, given differences in individual genetics, epigetnics, biochemistry, health status, microbiome, lifestyle, and goals? Such people may thrive, even long-term, with a VLC diet—but that does not mean that everyone will. 5. Even if ketogenic/VLC diet is therapeutic for a particular condition, that does not mean that 1) it’s the only effective therapy for that condition, or 2) that the condition itself was originally caused by eating too many carbohydrates. Both assumptions are logical fallacies. VLC diets have been shown to be effective for improving metabolic markers in T2DM, but so have restricted calorie diets, protein-sparing modified fasts, and even low-fat, high-carb diets. And just because restricting carbs can be effective in T2DM, it does not follow that too many carbs caused the condition originally, and that healthy people without metabolic problems should restrict whole-food carbs. Again, people with hemochromatosis need to eat less iron, but eating too much iron didn’t cause the problem in the first place. 6. Whole food carbohydrates, e.g. from starchy plants like sweet potatoes and whole fruit, do not affect the body in the same way as carbs from refined and processed sources, such as flour and sugar. Anyone with even a basic understanding of nutrition and physiology should understand this, but it’s remarkable how often this fact is overlooked in the “low-carb” discussion. I see so many people extrapolating the results from studies which look at the detrimental effect of processed/refined carbs to mean that we should avoid or restrict *all* carbs. That is a leap that cannot be made. I support what Laura has written in this article, and my experience working with patients is similar to hers working with clients. In the end, I have no problem with someone following a VLC diet over the long-term if 1) it improves their health, 2) it doesn’t cause adverse effects over time that could worsen their health. And I do have patients that fit into this category. However, I have quite a few patients—probably more—that do not. And given points 1-6 above, why would I (or anyone else) suggest that they persist in doing something that could harm themselves? That’s what blows me away about this “debate”. There’s really nothing to debate. The fact is, some people don’t do well with VLC. Why do people on VLC diets feel so threatened by that? Perhaps because, in some circles at least, VLC has become dogma: “a principle or set of principles laid down by an authority as incontrovertibly true.” And as the saying goes, you can’t fight faith with facts.
Posted on: Sun, 31 Aug 2014 18:32:33 +0000
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